Organization
111TH PHARMA-FAMILY
Active
Organization
111TH PHARMA-FAMILY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ADELE VANJACKSON RPH (OWNER/PHARMACIST)
(708) 503-9845
Entity
Organization
Contact information
Practice address
11101 S STATE ST, CHICAGO, IL 60628-4206
(708) 503-9845
Mailing address
11101 S STATE ST, CHICAGO, IL 60628-4206
(708) 503-9845
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
051035317
IL
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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